Survivor Link + Public Health AmeriCorps Interest Form
Thank you so much for your interest in the Survivor Link + Public Health Program! We are excited to work with you to support survivors in our community! As a member, you will engage in 675 service hours (between August 1 and July 31) to earn a $4,000 stipend and a $2,474.27 Segal Education Award, in addition to your field stipend of $6,000 (total value: $12,474.27). Service hours include internship, training in domestic violence by national experts, and engagement with a faculty mentor. 

We will be reviewing the applications and scheduling brief interviews on a rolling basis starting May 1 until all 12 spots are filled. If there is a good fit for the program, we will provide you with the full AmeriCorps application, which will be processed by ASU (i.e., for background check).

If you have questions, email Dr. Holmes at mxh540@case.edu
Sign in to Google to save your progress. Learn more
Email *
CWRU Email address *
Alternate email address *
First and Last Name *
Phone Number *
Who is your field instructor?
Have you identified a field placement for Academic Year 2024-2025? *
If yes, where will your field placement be?
What program are you in? *
Required
What year are you? *
Are you applying to participate or currently participating in another Fellowship opportunity at the Mandel School?
 *
Required
Why do you want to be a Survivor Link + Public Health AmeriCorps member? *
What ideas do you have for service projects related to domestic violence? *
Eligibility
The following questions determine AmeriCorps eligibility.
Are you a citizen, national, or lawful permanent resident alien of the United States?
 *
Are you planning to participate in Federal Work Study? (*FWS students are not eligible to receive the AmeriCorps stipend, but they can participate and receive the Segal Education award.) *
Will you be employed by your field placement site? *
Have you completed a previous AmeriCorps Service? *
If yes, how many AmeriCorps terms have you completed?
If selected as a CWRU AmeriCorps member, do you agree to to a background check and satisfy the National Service Criminal History Check eligibility criteria? Link: https://www.ecfr.gov/current/title-45/subtitle-B/chapter-XXV/part-2540/subpart-B/section-2540.202 *
Date of Birth (this is needed to provide to AmeriCorps for enrollment). *
MM
/
DD
/
YYYY
Thank you for applying for the Survivor Link + Public Health AmeriCorps program!

Dr. Holmes will reach out to you soon to schedule an interview!
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Case Western Reserve University. Report Abuse
Google Forms